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Monthly Archives: May 2012

The case of Lagos State Government vs. doctors took a bizarre turn when 788 doctors were summarily dismissed and replaced with 373; the alarming shortfall seemingly papered over.

And, so far, there are at least three factions of reactionaries: those who support the state; those who support the doctors; and others, like me, who will not take sides.

But I am sympathetic to the doctors because of my experiences in Lagos public hospitals. In December 2009, I waited nine hours to see a doctor at the Lagos State University Teaching Hospital, Ikeja. While waiting, others in the room kept murmuring that if they had money, they would go to a private hospital. My problem was the inverse; I was seeking expertise since the doctor in the private clinic I was using didn’t appear to be up-to-date (I had read more recent research online) and so I had insisted on a referral letter.

By 9pm when I eventually saw the doctor, he skimmed the letter and said, ‘I should admit you but there are no beds. Even the corridors are full. If you can wait for a bed to be vacant, fine. Otherwise, I am sorry.’ He then called the next patient. I should have railed at his evident lack of compassion to me but the manic sight of him was pitiable: His eyes were bloodshot and it was obvious he was tired and needed a nap badly. Earlier in the day, his colleague said something about having worked for 36 hours at a stretch and there was no relief in sight.

So, today, when people complain about the number of casualties of the strike actions, I tell them to spare a thought for those who have died because they were treated by fatigued personnel.

The second time was in 2010 and, this time, at the eye clinic. I went through a friend and, according to one of the nurses, his letter helped me scale a two or three months’ wait list. I ended up waiting a mere six hours! The eye clinic that day was like an extension of Balogun market; filled to the brim with a restive crowd. While waiting in the ophthalmologist’s outer office, I overheard her telling someone that they were being overworked and in her position, she has to research, teach and still see patients. And that she gets so stressed that she herself doesn’t trust any diagnosis she makes after 4pm. I carefully looked at my wristwatch.

Given my jaundiced visits to LASUTH, I don’t know which is worse: whether Lagos, the mega state as it prides itself, has such a paltry number of doctors or the sack itself.

Both sides have accused each other of various illegalities and immorality but, note, the Hippocratic Oath may be binding but there is no part that says they should tear their human bodies apart to save lives. Two, the state government too has a binding Oath on it not to toy with the lives or welfare of the people. Three, I am against doctors’ strike, anytime, any day but the government’s move is a wrong one. Nigeria is a signatory to the International Labour Organisation’s Decent Work Agenda. The Agenda states that labour is not a commodity that can be disposed at will. As the name implies, DWA ensures decent employment and it includes not throwing people out to prove a point.

I know some people have argued that the state had to resort to mass dismissal as a way of saving the system; I disagree. The system is actually worse off by tearing away people who have been in it for long and replacing them with neophytes. And considering that even the ones you sent packing were overworked, I wonder how those who are a fraction of their number will cope. When ex-governor Bola Tinubu gave the dismissal suggestion to Fashola in February, I thought it was one of those politicalspeak until it actually happened.

But then, what makes this action of ‘dismiss and replace them all’ dangerous is that it wields power; the power to subdue. The way power works — especially when the system reposes it in the hands of one man — is that it is powerful when it is not used. We know it is there and that is enough. It is not about being weak because it is strength on its own to not use power to quell those who are, in a sense, weaker. Power becomes diminished when it is used that way and to restore some mystique to it, you keep using it to suppress. It is a process that breeds tyranny. When personal ego gets intermeshed with it, it takes another face.

I once spoke to somebody about the case of the University of Ilorin lecturers and asked why he didn’t speak to former President Olusegun Obasanjo about it on a personal level. He said, “Once you mention that topic to Obasanjo, he will abuse you, abuse your father and the rest of your lineage.” We all saw how that story ended. It is a similar path I wish Lagos State will not tread. Just a year ago, the Action Congress of Nigeria used Lagos State as its poster boy for good governance. Other South-West state governors, more or less, rode on the strength of Fashola’s popularity to power.

There is no point engaging in unalloyed propaganda about the ‘state-of-the-art’ facilities in Lagos State hospitals or that the governor goes there to check his blood pressure once in a year. The truth is, the health care system needs to be humanised and both the state and doctors are not exempt from this responsibility. There are better ways to resolve issues than showing power pass power. The already bad situation will become worse if the call for a solidarity strike by doctors in the employ of the Federal Government takes effect tomorrow.

In the long run, strikes can be avoided in the essential services sector if we devise a mechanism, one independent of both parties, that’ll govern the standard workings of the system and which will guide all parties as to what their responsibilities are. Such a mechanism, periodically reviewed, can critically and fairly examine working conditions and other aspects to preempt and prevent disputes and strikes. In the meantime, they should be less recalcitrant and seek arbitration. After all, it is lives we are talking about.

Like this:

Our dear friends in the fourth estate of the realm, on behalf of the Nigerian Medical Association, I most warmly welcome you to this Press Conference designed to update you and the general public on our Association’s views on the lingering crisis in the health sector of Lagos state, occasioned by the face-off between the Lagos state government (LASG) and the Medical Guild.

As you are all aware the current dispute between the Lagos state government (LASG) and the Medical Guild did not start today. It dates back to September 2009 when a new salary structure for medical/dental practitioners (the Consolidated Medical Salary Structure; CONMESS) was circularized by the government. Thereafter, between the months of September and November 2010, several meetings took place between the LASG and the Medical Guild with the aim of securing the implementation of Full CONMESS in Lagos state. These engagements culminated in a signed agreement to implement CONMESS by the Lagos state government, with the effective date of implementation put at January 2011.

Whereas, the public thought that the signed agreement was going to put an end to the face-off, believing that the LASG was going to faithfully implement the signed agreement, later events were to prove them wrong, as the public and members of the Medical Guild waited in vain for the full implementation of the signed agreement.

On account of what was perceived as the reluctance of the LASG to implement what she had signed as well as the introduction of compressed Salary Grade level steps for doctors employed by the LASG, the Medical Guild resumed her industrial action in the month of February, 2011. This was later to be resolved through the intervention of Senator Bola Ahmed Tinubu (former Executive Governor of Lagos State) who, along with the Commissioner of Health, Dr. Jide Idris, and the Chairman of Action Congress of Nigeria in Lagos state, Sir.Henry Ajomale, brokered an agreemement on behalf of the Lagos state government on March 24, 2011, with promises that:

1) CONMESS will be paid in FULL to all doctors, with no compression of salary grade level steps; and

2) that allowances will be classified as non-taxable, with further welfare packages developed to improve the working conditions of all healthcare providers in the state.

Though the Medical Guild suspended her industrial action to give room for the implementation of the new Memorandum of Understanding (MOU), she was disappointed that again the Lagos state government did not keep faith with her own part of the bargain. Sadly, all attempts at convincing the Lagos state government to faithfully implement the signed agreement ended in vain. Having waited for over 12 months with their demands unmet the Medical Guild resumed their earlier suspended strike action.

Since the commencement of the strike action by the Medical Guild, there have been several unsavoury events in the health sector of Lagos state, including the unprovoked intimidation, incessant police harassment and sack of over 700 medical/dental practitioners in the employment of Lagos state government, as well as the recent forceful eviction of the same medical/dental practitioners from their residential quarters.

MEDIATORY ROLE OF THE NATIONAL BODY OF NMA

Exactly a week ago at the 52nd Annual General Conference/Annual Delegates Meeting of the Nigerian Medical Association, the crisis in the health sector of Lagos state was deliberated upon. It was the resolution of the NMA that inspite of the degeneration of the crisis, the National body of the NMA should initiate a genuine dialogue of both parties in the dispute. This informed the constitution of a body of Elders commissioned by the NMA to go into dialogue with the Lagos state government.

Distinguished Men and Women of the fourth estate of the realm, the national leadership of the NMA came into Lagos state yesterday, Thursday, 10th May, 2012, to seek a mediated settlement of all the issues in dispute, with the aim of getting back on track the healthcare system of Lagos state.

Having secured an appointment with His Excellency, the Executive Governor of Lagos state, Barr. Babatunde Raji Fashola, a meeting took place between His Excellency and the President of the Nigerian Medical Association, Dr. Osahon Enabulele. At that meeting, the NMA President impressed on the Governor the need to urgently put the current crisis to bed through genuine dialogue, as it is in the interest of Lagos state government.

The Governor expressed his commitment to the resolution and directed the Head of Service to meet with the NMA to resolve the matter, with a promise to faithfully implement the outcome of our engagement with the Head of Service.

Sadly, after over 4 hours of engagement with the Head of Service of Lagos state, the Commissioner of Health, Dr. Jide Idris, Permanent Secretaries and other officers of the state government, the initiated dialogue ended in a deadlock occasioned by the fixated and vexatious position of the Head of Service that the Lagos state government had resolved to discipline her doctors the way she had done it, and that the matter was beyond him.

Whereas the NMA was resolved to sacrifice all the time to ensure a negotiated settlement of the crisis the mulish posture of a conqueror exhibited by the Head of Service acted as a wet blanket, hence the NMA thought it necessary to brief the general public on our findings and the way forward.

OUR FINDINGS/ OBSERVATIONS

1) Whereas the Lagos state government signed an agreement to implement, with effect from January 2011, a mutually agreed salary structure for medical/dental practitioners which will not put them at a comparative disadvantage to their counterparts in other health institutions, the NMA observes that this agreement by the Lagos state government has not been kept as the current operational salary structure for medical/dental practitioners in Lagos state clearly puts them at an obvious disadvantage with the extremely unexplainable and strange compression of salary grade level steps. This development not only amounts to salary losses, but more fundamentally conduces to a forced retrogression of the career paths of medical/dental practitioners employed in Lagos state as between 3 and 7 years of service to Lagos state government was swept away by this action. Additionally, the loss of steps by these doctors will also affect their retirement benefits, and puts them at a disadvantage if they chose to transfer their service to another government.

2) Whereas Asiwaju Bola Ahmed Tinubu (former Executive Governor of Lagos state), Dr. Jide Idris (Lagos state Commissioner for Health) and Sir Henry Ajomale (Lagos state Chairman of ACN) signed on behalf of the Lagos state government, an MOU with the Medical Guild dated March 24, 2011, to pay CONMESS salary in FULL to all doctors with no compression of grade level steps, there is nothing to show that this agreement has been kept.

3) Whereas His Excellency, the Executive Governor of Lagos state, Barr.Babatunde Fashola, at one time approved and directed the payment of a mutually computed Salary/CONMESS salary structure which needed only an extra N29Million naira monthly, it is sad to note that between His Excellency’s Office and the Office of the Head of Service, that promise and directive arcanely disappeared into thin air.

4) Whereas the Medical Guild wrote several letters to the Head of Service requesting for a meeting with the Lagos state government to sort out the outstanding issues, the Head of Service chose to officially ignore the Medical Guild as no official response to their request has been received to date.

5) Whereas, the Medical Guild out of frustration with Government’s evasive tactics met and collectively resolved to resume their earlier suspended strike action, the State Government’s response through harassment, traumatization of doctors, issuance of mass queries and sack letters, smacks of military dictatorship, totalitarianism and democratic insensateness.

6) Whereas NMA recognizes the right of all citizens to assemble and associate to protect their interest, as guaranteed by section 40 of the 1999 constitution (as amended), the NMA is unhappy with the attempts to fracture and decimate the Medical Guild. NMA totally frowns at this attempt.

7) Whereas the NMA recognizes the right of all citizens to express their fundamental right of freedom of speech, for all those who claim to be members of the Nigerian Medical Association by virtue of their registration with the Medical and Dental Council of Nigeria, the NMA will not tolerate any reckless, unethical and fissiparous action by any of her members that seeks to put the Association or Medical Profession in bad light or into disrepute. Accordingly, all such members are warned to desist from such untoward and opprobrious acts.

8) Whereas the NMA notes that hitherto the Doctor-Patient population ratio in Lagos state was 1:14,545 (far from the African standard of 1:10,000 and the global standard of 1:1000), the current action of Lagos state will further worsen this ratio with poorer health indices (Maternal Mortality Rate, Infant Mortality Rate, Under-5 Mortality Rate, etc) bound to emerge on account of the reduced medical manpower and poorer access to healthcare.

9) Whereas the NMA recognizes the right of an employer to employ her staff, the NMA frowns at the on-going casualization of the Medical Profession in Lagos state, as exemplified by the purported locum appointment offered by the Lagos state Health Service Commission. While we challenge the Lagos state government to publish the full list of those she claimed to have so far employed, we urge all medical/dental practitioners to be very wary of such appointments aimed at denigrating the Medical Profession.

WAY FORWARD/RECOMMENDATIONS

1) While the Nigerian Medical Association appreciates the reception offered the NMA by His Excellency, Barr. Babatunde Fashola, it is the well considered position of the NMA that the current state of affairs in Lagos state demands a movement from Administrative grandiloquence and fantasy to Administrative Realism, by faithfully implementing all promises and signed agreements with the Medical Guild. The true test of a leader is his/her faithfulness to collective agreements, for Machiavellianism is never welcome in a people-led democracy.

2) While the NMA frowns at any attempt to assault the Medical Profession, we totally reject the on-going sack, publication of the salaries of medical/dental practitioners, traumatisation and forced eviction of doctors in the employment of Lagos state government despite the existing Lagos state Tenancy Law. We appeal to all our affected colleagues to remain calm as it is always darkest before dawn.

3) While we direct the state branch of NMA to explore all options she deems fit, the National Body of the NMA will be convening an Emergency Delegates Meeting soon, to review the current situation and take a national position.

4) The NMA restates her willingness to partner with the Lagos state government and other state governments in Nigeria in the task of enthroning quality, accessible and robust healthcare services. In particular, our doors of engagement are still open to the Lagos state government, and we sincerely hope this window is genuinely utilized.

STRIKE ACTION BY OTHER HEALTH WORKERS IN NIGERIA

While the Nigerian Medical Association recognizes the right of any citizen or group to advance individual or collective interest, we note that the current strike action by other health workers under the guise of JOHESU has no bearing on international best practices or professionalism of the health sector in Nigeria, as it is all a calculated attempt to undermine the professional status and position of medical/dental practitioners.

While we urge the Federal Government to do nothing that will further worsen the crisis in the health sector, we note with happiness the quality services being rendered by medical/dental practitioners in hospitals across the country. We wish to encourage them to remain at their duty post to render their best to their patients, despite all encumberances.

APPRECIATION

1) The Nigerian Medical Association sympathizes with the good people of Lagos state and sincerely appreciates all for their patience, support and understanding. We assure them that we shall zestfully work to end the current crisis.

2) We also wish to appreciate all individuals, groups and societies who have so far made effort to end the current crisis.

3) We appreciate all our members nation-wide for their tolerance, patience and understanding. We assure them that we shall always protect their individual and collective rights.